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This column is about overcoming trauma, which can be a serious mental health concern. I am not a licensed therapist or mental health provider, just a lady who has seen her share of stuff and is willing to talk about it and what I’ve learned. If you feel like you are in need of help to work through your trauma, or your trauma is causing a disruption in your daily life, please see a licensed mental health provider. If you are at immediate risk to yourself or others call 911.
How do you get over a trauma? How do you deal with triggers that keep bringing it all back when you thought you dealt with this years ago, then boom, it’s back and you find yourself going back down in the nightmare.
Trying to shake it off again,
You aren’t alone, although it likely feels like it. My experience with trauma was one of the loneliest times of my life. I felt like I was going insane and it made no sense. I didn’t know who I was and what was wrong with me. I was terrified to say anything to anyone because I was too strong and independent to be having a mental breakdown.1
Trauma is sometimes referred to as the silent scream. If you’ve experienced PTSD this makes total sense. For those people who haven’t, it’s a good description. PTSD is your brain is screaming that you’re in grave physical danger, while your body is responding in ways that aren’t logical to you or anyone around you- but you just have to react in a way that keeps you safe… from something that’s not currently happening.
Logic can’t overrule the deep, evolutionary reaction of the chemicals and hormones in your brain that are reminding you that there is a tiger in the grass, and he’s going to eat you if you don’t run. This is because it’s the only way you were safe the last time there was a rustling in the grass the tiger almost got you! 2
I don’t know the specifics of the trauma you’re dealing with right now, but the symptoms of trauma on the brain and body are pretty similar regardless of the cause of the trauma.
The Car Accident – My experience with PTSD
In October 2013 I was in a traumatic car accident resulting in severe PTSD. My kids and I hit black ice while driving through a canyon in Central Utah, sliding off the road and over the edge of the canyon, rolling our SUV until we came to a brutal stop at the bottom.
It was my first acute trauma experience and the months that followed are still a bit of a blur.
About six weeks after the accident I was sitting in a college class when for no apparent reason (other than the PTSD) I had a flashback. I couldn’t identify the trigger that day, but was the same flashback I was experiencing as nightmares all night long. This was the first time it happened during the day.
I was sitting at my desk, trying to pay attention to the lecture, when instantly my stomach lurched with the familiar feeling of the front passenger tire leaving the pavement and dropping into nothingness. I’d been waking up to that feeling multiple times a night. The feeling of the tires hitting empty air as the car dropped over the edge of the road. There was nothing I could do to stop it that morning. There was nothing I could do to stop it at night. But now I was awake and couldn’t stop it either.
The walls began to close in on me.
I couldn’t breathe.
It didn’t make sense, but if I didn’t leave that instant I was going to have a complete breakdown in front of my entire class. I needed to breathe. The walls were closing in and I had to escape, or I would suffocate.
I ran out of the room and hyperventilated in the bathroom until I puked.
Several weeks later, after not sleeping more than a couple of hours at a time, and having debilitating flashbacks during the day, I had my first panic attack while driving. This was when I finally reached out to a trusted friend for help.
Jo is 3 older and 4 wiser than I am, and was one of my closest friends and confidants. I didn’t know what to do. I couldn’t think straight. I knew I was not completing my work in my classes, couldn’t retain information, couldn’t interact with my kids like I was used to and just wasn’t functioning overall. But now I didn’t feel safe to drive any further.
Crying, shaking and terrified of just how out of control I felt, I called Jo from the side of the road. I sobbed and told her I couldn’t breathe, hadn’t slept through the night in weeks, and I didn’t know what to do.
Jo listened to me and told me I needed to get professional help. Not later, but now. I didn’t realize how bad I sounded until she reflected back to me what it was she was hearing me say.
It hadn’t occurred to me that I needed to seek help from a professional. I felt ridiculous that the accident was affecting me as much as it was. We were all fine. We were lucky. We shouldn’t have all walked away unhurt, but we did.
The car had also been manufactured for accidents just like this or worse. The crumple zones did their job. The airbags deployed. The safety glass broke but didn’t shatter. Thank goodness we were all wearing our seatbelts.
The only therapist I had to call was the marriage therapist I had seen a year ago. Jo made me commit to call her right now and then to call her back and report. If the therapist was unavailable then I needed to call someone close by to take me to an emergency room and get immediate help.
My therapist answered the phone. She walked me through some visualization and breathing exercises on the phone and helped me calm myself down until I was safe enough to drive. We made an appointment for the next day, but I was to call her anytime between now and then if it started up again, and if she was unavailable, I was to have someone take me to an ER.
That was perhaps the scariest thing I’ve ever heard, that I was so out of control that I needed to consider emergency professional mental help. Even scarier was my inability to recognize just how out of control of my emotions were, and that physical reactions to those emotions were taking over my life. I couldn’t see it. What was real to me wasn’t reality.
****Trigger warning over*****
I worked through my PTSD and trauma over the next several months with my therapist. We used a combination of EMDR and talk therapy to reduce the frequency and severity of the memory of the trauma and reduce the triggers. For the times when I was still triggered and anxiety or panic took over, she taught me valuable visualization and self-regulation tools.
Over time, my acute symptoms of PTSD from the accident faded and I had major tools in my toolkit that helped not only in that instance but have helped in other traumatic situations since.
I’ve got science and all sorts of logic and reasons why that science works, but first, I want you to know a few things that I’ve learned by living through my own traumatic experiences and helping my kids and friends with theirs.
Five Things to Know About Trauma
- Talk about your trauma. Ask for (professional) help. Shame is toxic.
Typically as a result of trauma, we end up shaming ourselves for how we’re dealing (or not dealing) with the traumatic experience. Whether it comes from your reaction at the moment, your perception of responsibility for the situation, or any other reason, shame makes it worse because it prohibits us from seeking the help we need and prohibits receiving support from the community.
Asking for help from professionals is the best way to work through trauma. Actively seek help from a professional. Make an appointment with a trauma-certified therapist. There are evidence-based practices for treating trauma and there are medications for acute symptoms.
If you’re being triggered by a trauma that is more than a month old, you are suffering from PTSD, which we can see the effects of using FMRI brain scans. There has been physical damage to your body, you just can’t see it. If you were suffering from a broken leg you would seek professional help to help your body heal. Your brain is no different. Shame (and fear) are a couple of emotions that can prohibit us from taking the steps to get healthy.
- Traumatic experiences vary- pain and trauma aren’t a competition.
Two people can have the exact same experience, at the exact same time, and one will be severely traumatized and develop PTSD and the other won’t. It’s not about mental fortitude or being “strong.” It’s about brain chemistry.
“At least it’s not…” is a way to invalidate your experience. Don’t do it to yourself. Don’t let anyone else do it to you either.
There is always someone out there who has had a more difficult life experience than you, it doesn’t mean that your trauma isn’t still your trauma. You deserve to be treated with love and care. Your pain is valid. Minimizing your pain will make it worse, not better.
- Emotions aren’t logical or linear.
It’s nice to picture difficult experiences and unpleasant emotions as something you gain distance from. As time passes and the memories retreat into the past then they should disappear you never need to re-visit them again… right? But, unfortunately, it seems the more difficult the emotion, the more often it comes around and at super-awkward times without explanation. I most frequently say this about the grief from the loss of a loved one, but grief is also a traumatic event!
Emotions don’t logic and they will generally keep coming back around, intensifying the more you try and ignoring them. Which leads to my next point.
- Avoidance is instinctual, but not helpful for healing.
The way we instinctively react to the triggers of trauma is actually quite predictable.
Trigger –> Re-experience –> Emotional arousal/reaction –> Avoidance
The problem is that this is exactly what we shouldn’t do to “get over” trauma. (Thanks a lot brain.) Remember the “not linear” part from above? The instinctual process of trauma reactions is more of a cyclical pattern.
Trauma isn’t “gotten over” it’s processed through. Processing the experience, building new neural pathways, is proven to be the best way to reduce the effect of trauma triggers in our brain.
Understanding how trauma works in our brains is the key to understanding how to process it. The good news is that what we know about how trauma is stored in the brain allows us to process the traumatic events to reduce our memories and emotions. I’ll totally nerd out on that below with a lot more detail. But I want to paint a picture for you first.
Pretend your brain is a giant map. You have paths worn into the terrain that help you get the places you need to go easily. There are paths so worn you don’t even think about them anymore. If you want to get from the part of your brain that knows how to communicate in English you don’t have to think about how to form the words and shape your tongue to make the right sound while also putting the words in the right order. You just do it without thinking. That pathway is worn so well into your brain map that your little brain avatar races so fast to the language destination you don’t even see it happening.
If you are trying to learn a new language, you’ve got to carve an entirely different pathway into brain terrain. You do this by practicing over and over, learning new words, learning how to make sounds that are new to you and assigning meaning to an entirely different vocabulary than you are used to.
Trauma, because of how important it is for your brain to understand how NOT to be in this situation again, uses a shortcut. Even faster than thinking about communication, when your brain senses life-threatening danger, your brain avatar burns a pathway through the terrain to the “keep my human safe” destination. By avoiding thinking about the trauma we aren’t avoiding the path, because it’s deeply, deeply ingrained in our brain terrain.
Instead, the solution is to do the same thing we do when we learn a new language. We’ve got to carve an entirely new path for our brain map.
We have to learn new responses, learn how to assign new meaning to experiences and teach our brain that the experience we had happened in the past and is no longer a threat. This is one of the major issues with trauma, the inability for our brain to time-stamp the moment of trauma as being over. Carving a new path allows the old path to grow over and not be used anymore, putting in our memory as “something that happened but isn’t a threat anymore.”
The brain’s ability to do this is referred to as neuroplasticity and is the same reason stroke victims can learn to walk again and people with traumatic brain injuries who lose the ability to talk can relearn. The therapies I mentioned above (EMDR and Exposure Therapy) are a couple that are used to “rewire” the brain after trauma.
- Five F’s of (immediate) trauma reaction
Our reactions at the moment of trauma come from deeply ingrained instincts that are the reasons why we’ve survived to this point. You’ve likely heard of “fight or flight” but there are five normal reactions to trauma are to flee, freeze, fight, feed or f*ck. (Sorry, that’s the 5 F shorthand).
I’m telling you this because you not only likely experienced one of these in the moment of trauma, but may also be using any of them as a coping mechanism when you’re triggered. These reactions are often the source of continued shame and pain in regard to our trauma. They are also frequently the reason people victim-blame/victim-shame survivors of traumatic events.
This is why I needed to leave the room (flee) when I was triggered in my first panic attack after my accident. It’s why many sexual assault victims freeze and can’t move or react when they’re being assaulted, and why they may have the same reaction when they’re triggered in consensual encounters after the assault. It’s also why victims of trauma may become intensely angry, hypersexual or experience eating disorders. It’s how our brains react to trauma. It’s why seeking help is important.
Untreated trauma can also result in depression, anxiety, chronic pain, drug and alcohol abuse, sleep problems, panic attacks, nightmares, self-destructive thoughts or actions, hyperarousal, avoidance of usual activities. Our current culture tends to mock people who speak up about their traumatic experiences and/or who ask for consideration for those who are sensitive to situations based on life experience.
Simultaneously, our current culture is suffering an all-time high for some of the results of untreated trauma. If we follow the trauma, treat those suffering with love, compassion and the tools to heal, then we just might find solutions to some of these other problems as well. About 70% of the population will experience trauma in their lifetime, and of those, about 20% will suffer from PTSD- or the effect of the trauma a month after the event. Understanding more about trauma is helpful for ourselves, but also as we encounter people in the wild who seem to be acting in a way that doesn’t seem to make sense for who they are as a human or for the situation.
The more I’ve learned about trauma through my own acute experience and another chronic trauma experience, in addition to researching for a client I worked with in the field, the more I’ve seen trauma reactions around me in many places. Giving people space, grace and compassion is a better place to start pretty much always. This includes yourself. Self-compassion is where you start practicing space, grace and compassion first.
On to the nerdy nerd stuff. I think the neuroscience behind why we react the way we do to trauma is fascinating. It helps me to have the knowledge and the logic to try and make sense of why I’m acting/reacting in a way that doesn’t make sense… because it doesn’t make sense in the current timeline and way life is, but it DOES make sense when you understand the evolutionary reasons for why our brains do to us what they do.
What is Trauma?
There are a couple of different kinds of trauma and while they may look different from the outside, they aren’t really treated differently by our brains.
Acute trauma is the consequence of exposure to extreme traumatic experiences like car accidents, assault, robbery, rape, combat, torture. The traumatic experiences may happen to you – or you may witness them happening to someone else. But it’s one, scary, impactful moment that (typically) makes you fear for your life at that moment.
Chronic trauma is the result of ongoing exposure to trauma. Experiencing trauma as a result of multiple, or ongoing traumatic situations. Examples of chronic trauma include ongoing combat service, abusive (physical, emotional or financial) relationships, food or shelter insecurity and other situations where the basics of life aren’t stable. Most childhood trauma is of the chronic variety.
Childhood trauma (ACEs) can be either acute or chronic, but the effects of childhood trauma are just really beginning to be studied in ways that demonstrate just how important it is to keep children safe and secure.
To summarize, there has been a test developed to measure Adverse Childhood Experiences (ACEs) and then track the results of these experiences when these children become adults. The research shows that trauma in childhood causes not only lifelong effects on the child themselves but also may affect those children’s children. These events include children who are exposed to abuse, neglect, have a mentally ill parent, or a parent addicted to drugs or alcohol.
A high ACEs score means you are three times as likely to have heart disease and lung cancer and their life expectancy is 20-years less than those without exposure to childhood trauma.
There is (highly contested) preliminary evidence in the field of epigenetics that the effects of trauma may be imprinted our DNA moving forward. This is so our children and their children will react to danger in ways that keep them safe. Think of it as our DNA having the “memories” of our ancestors that tell us that cliff edges are dangerous, fire can destroy… and that people who look, think and act differently than us could hurt us and we should be careful.
Your Brain on Fear/Stress
The parts of your brain affected by trauma and that are responsible for trauma responses are the amygdala, hippocampus and the prefrontal cortex. They all help you regulate your emotions and respond to fear.
Fear starts in the amygdala- it’s deeply subconscious and not something we can consciously control. The “Five F” response starts here. It triggers the release of stress hormones and causes reactions in your nervous system. You become hyperalert, your oxygen intake increases by dilated bronchi in your lungs and your breathing accelerates. Your heart rate increases and your blood flow and the amount of glucose going to your muscles increases with it.
Essentially, your amygdala has prepared your body to respond to the danger that you may not even have consciously seen yet. This is the “emotional/reptile/evolutionary brain” response that keeps us safe when there is a threat to our lives, like if we were walking down the street and a tiger jumped out of the bushes at us.
Another job of the amygdala is to remember fear-inducing events, but also to remember positive events as well. While the research isn’t yet conclusive, one perspective is that the amygdala is involved in evaluating the environment to determine what in the environment is important and reacting appropriately.
Your hippocampus and prefrontal cortex are the “thinking brain” that can take the information and interpret the perceived threat, processing surrounding information to tell us that the tiger in the grass is also behind a fence at the zoo so we don’t need to fear for our lives.
Your Brain on Trauma
This is the super-simplified summary and there are a lot of other things in play, but in FMRI and Microdialysis studies they’ve seen people who are suffering from PTSD have overactive amygdalas.
The effect of this is that a person suffering from PTSD is in a constant state of stress and hyperawareness. If everything is a threat then you’re constantly (subconsciously) scanning the environment for the next tiger and reacting to it. Your hippocampus and prefrontal cortex aren’t able to properly interpret the threat because the time-stamp on the threat is immediate, not in the past.
Learning this helped me better understand why it was so hard to move past my accident. My brain kept playing and replaying that first moment of the accident in an effort to remind myself it wasn’t safe. My brain explored all of the possible outcomes and kept replaying them for me because it could have been worse. I shouldn’t have survived. I needed to know this so I could be safe. My brain was just doing its job. But it was really ruining my life.
Your Brain on Resilience
Some people have brains with larger amygdalas than others and there are some who hypothesize that those are people who are more prone to anxiety overall and more prone to suffer from PTSD after experiencing trauma, as opposed to those who are able to walk away from the same experience shaken, but not traumatized.
But genetics and biology aren’t the only factors in who experienced PTSD and who doesn’t. There are specific social, environmental and actions you can take to increase your resilience after a traumatic event.
Think about the ability to recover from trauma as similar to recovering from any other injury. If you were to have major surgery and come home to an environment that was dirty without adequate heat and lacking clean water and also not having anyone else to help you recover and give you time to heal, you aren’t likely to recover at all, or at least not quickly.
It’s the same when recovering from trauma. A solid support system, coping strategies, recognition of the need to take time to recover emotionally are vital when recovering from a traumatic experience.
According to the National Institute for Mental Health, there are life factors that can increase your risk after trauma:
- Living through dangerous events and trauma
- Getting hurt
- Seeing another person hurt, or experiencing trauma
- Childhood trauma
- Feeling horror, helplessness or extreme fear
- Having little or no social support after the event
- Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
- Having a history of mental illness or substance abuse
But the NIMH also includes factors that may promote recovery after trauma:
- Seeking out support from other people, such as friends and family
- Finding a support group after a traumatic event
- Learning to feel good about one’s own actions in the face of danger
- Having a positive coping strategy, or a way of getting through the bad event and learning from it
- Being able to act and respond effectively despite feeling fear
One of the best books I’ve read recently about resilience after trauma is Option B by Sheryl Sandberg and Adam Grant. They give concrete steps for building resilience and stories about how to implement them in your life.
Your Brain on Therapy
Not everyone who experiences trauma needs therapy to work through the event. But if you are experiencing any of the following you should seek out professional help:
- Having trouble functioning at home or work
- Suffering from severe fear, anxiety or depression
- Unable to form close, satisfying relationships
- Experiencing terrifying memories, nightmares or flashbacks
- Avoiding anything that reminds you of the trauma
- Emotionally numb and disconnected from others
- Using alcohol, drugs or other addictive behavior to disconnect and feel better/feel nothing
Therapy gave me tools to use to minimize triggers and stress in the moment of being triggered. I found visualization exercises like The Rock and Unwinding Anxiety to be very helpful.
These tools helped during the process of rewiring my brain and the trauma reactions. Both of them were exercises I could do in a room surrounded by people or in my bed in the middle of the night when I woke up from a nightmare. Both are exercises I use now when I need to, although I need them much less frequently than I used to.
I have also used meditation and yoga with similar positive benefits for ongoing calm for the anxiety that accompanies me if I’m not on top of it by being proactive. I think this anxiety is something that’s always been part of my life, but I didn’t recognize it as something that I could actively do anything about until after experiencing PTSD.
In reviewing the strategies by the NIMH for resilience I realized that many of the tools and support in the list are the direct result of therapy. Talking through my experience and the weeks that followed and being validated by my therapist as she helped me sort through the experience and validated my emotional state.
Additionally, EMDR Therapy was where I found my greatest relief. It was something I knew nothing about until I was experiencing it. I just got lucky in my choice of therapist. EMDR stands for Eye Movement Desensitization and Reprocessing. It incorporates CBT (cognitive-behavioral therapy) with bilateral eye movements that help with the “rewiring” of the brain so the trama can be filed away as a past event by desensitizing the trauma.
Honestly, it felt a bit “woo woo” to me at the moment. But it really worked. It’s also been evaluated in randomized controlled studies, approved for use by the World Health Organization, the American Psychiatric Association and the Department of Veterans Affairs and Department of Defense. Learn more here.
You are not alone. Even all the science and reasons and stuff don’t make anything immediately better. Reaching out and asking for help is a great first step. This sounds like something you’ve been dealing with for a long time. That’s a heavy burden to carry. I would encourage you to call a therapist for help. Set up that first appointment. It’s a great next step to take so you can heal.
- PTSD Stats Science: How trauma changes the brain
- Brain Model of PTSD – Psychoeducational Video: If you only watch one video, watch this one. Understanding just how trauma memories work is vital. PTSD Warning signs: (video) what does PTSD look like? How does post-traumatic stress disorder change the brain? (article) How childhood trauma affects health across a lifetime (video): Nadine Burke Harris talks about how childhood trauma is literally killing us as adults. The Effects of Trauma, with or without PTSD, on the Transgenerational DNA Methylation Alterations in Human Offsprings. Study researching how trauma affects DNA methylation from mothers to children. Functioning neuroimaging studies of post-traumatic stress disorder. Study about how PTSD shows up in the brain. Neural plasticity and 4 steps to change your brainCan emotional trauma cause brain damage? A great article about the parts of the brain and what happens in a trauma situation
- Epigenetics: Inherited trauma shapes your healthA painful legacyCan we really inherit trauma?
- Triggers:Triggering 101 How to identify and cope with PTSD triggersCommon Reactions to Trauma
- Trauma Therapies and Tools: EMDR Therapy for PTSD and Trauma: (video) How EMDR worksReturn from Chaos: Treating PTSD (video) Treating trauma with exposure therapyWhat trauma taught me about happiness: (video) Overcoming negativity bias, anchoring, attachment, perspective and reframingACEs test: Quiz to measure your exposure to trauma as a child.
- Other Tools: Grounding: a practice to help you pull yourself away from flashbacks, anxiety attacks, or other challenging or negative emotions. Container Meditation: (video meditation) a meditative practice to strengthen when to explore hard emotions and when you want to put it away.
- Resilience: The three secrets of resilient people: (video)
- Spoiler alert: No one is “too strong” to have a mental breakdown. You know who the strong people are? The ones that ask for help.
- Metaphorically speaking
- a few years
- much, much